Botulinum Toxin Type A as a Reversible Treatment for Residual Fourth Cranial Nerve Palsies, Secondary to Intracranial Hypertension in the Context of a Ventriculo-Peritoneal Shunt Failure

This case report illustrates bilateral fourth cranial nerve palsies in the setting of an intracranial hypertension, secondary to a ventriculo-peritoneal shunt failure. More importantly, it shows how diminishing the impact of a fourth cranial nerve palsy in an active patient's life can be obtained by a single injection of botulinum toxin type A in the ipsilateral inferior oblique muscle.